Random musings by people who think about educational psychology and the practice of instructional design

February 25, 2015

Applying Intersectionality to Health Professions Education

by Caitlin Leach,
Pharm.D., PGY1 Community Pharmacy Practice Resident, University of Maryland
School of Pharmacy

Health professions are comprised of a distinct group of people with specific
domains of inquiry possessing language, methods, and skills within a focused
framework. While health professions
education encourage the acquisition of an impressive depth of knowledge, they limit
the scope of practitioners’ expertise. A
common solution to this issue involves promoting interprofessional education. Theoretically,
this exposes learners to other areas of specialization in order to provide a
more holistic approach to the task at hand.

I argue that this is not an adequate solution.

Interprofessional approaches involve temporary overlap of profession-specific
frameworks to provide insight and new knowledge regarding a particular task.
Unfortunately, this categorizes information outside the practitioner’s framework
as the responsibility of other professions. This approach is appropriate when
complex tasks have access to an interprofessional perspective. However, often
in pharmacy practice, particularly in settings where patients face barriers-to-care
and lack-of-access, complex cases must be solved independently
of additional practitioners’ perspectives. To address this gap, pharmacy students
need more exposure — not to interprofessional education, but to intersectionaleducation.

“Intersectionality” is a sociological theory coined by Kimberlé Crenshaw
in 1989.1 The theory postulates that multiple axes of identity
contribute simultaneously to a person’s experience of oppression and
discrimination.The typical
manifestations of oppression - sexism, racism, classism, biphobia, homophobia,
transphobia, and belief/cultural-based prejudice – cannot be examined
independently because they contribute to inequality in a way that is interconnected
and interrelated. Instead, intersectionality offers a holistic framework to
evaluate the impact of multiple identities contributing to a person’s
experience of inequality.1 Borrowing the concept of
intersectionality, it can be applied in health professional education and used
to help students see the multiple determinants contributing simultaneously to a
patient’s experience of health.

This figure
illustrates various axes of human identity converging to a point of
intersection

Similar to identity, the origin of poor health is multifactorial and
cannot be examined through a singular lens. Pathophysiologic and psycho-social
determinants of health are interconnected and interrelated. While interprofessional
approaches provide a different perspectives, from ability (physical therapy),
family and income status (social work), to mental health (psychology,
psychiatry), and others, it is imperative for pharmacists to be able to incorporate
these health determinants when making therapeutic decisions in the absence of consulting
other professions. In healthcare education, intersectionality can be applied to
patient cases with the realization that health is not determined by any one
thing. Through addressing psycho-social health determinants and discussing
their impact on pharmacotherapeutic decision-making, intersectionality can
provide students with a more complex understanding of health in order to
address the needs of diverse patient populations.2

Intersectional case studies could explore a variety of questions
including:

What does lifestyle modification look like in a patient with diabetes
on a fixed-income, with limited access to reliable electricity and heat, and
sporadic medication adherence due to transportation issues to the pharmacy?

In a patient with metabolic syndrome, depression, and anxiety that loses
insurance coverage and can only afford half of her medications, which 5 of 10 medications
are the most important in maintaining her health?

What preventative care and screening recommendations do you make for
male, female or transgender patients lacking primary care providers?

Adding layers of complexity regarding the human experience to patient
cases can aid students in making the transition from the classroom to practice.
Using intersectionality to address health disparities and improve health
outcomes will also lead to more encompassing, holistic healthcare.3Intersectionality provides a framework for pharmacy education that takes into
account the complexity of health and human experience rather than reinforcing barriers-to-care
as the responsibility of other health professionals and, in effect, perpetuates
health disparities.

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